OCCUPATIONAL THERAPY
AND IDEOLOGY:
A CRITICAL INVESTIGATION
Tania van der Merwe
2006
Dissertation submitted in full requirements for the
Master’s Degree in Occupational Therapy,
Faculty of Health Sciences,
University of the Free State.
Supervisor:
Prof. Johann Visagie, Department Philosophy, UFS.
Co-supervisor:
Dedicated to all philosophers in/of Occupational Therapy.
Read not to contradict and confute;
nor to believe and take for granted;
nor to find talk and discourse;
but to weigh and consider.
CONTENTS
Acknowledgements
iPreface
iiSynopsis
viSinopsis
viiiINTRODUCTION AND OVERVIEW
1. A Question of Being Relevant: The Occupational Therapy Identity 1 2. The OT Identity and Critical Self-Reflection: Choosing and
Articulating a Suitable Epistemology 5 3. The OT Profession Engaging in Systematic Self-Clarification:
Investigating Ideology Theory as a Means of Critical Self-Reflection 7 4. Clarification of Terminology Often Used 10
5. Overview of This Study 12
CHAPTER 1
1. The Nature of this Study: A Journey Between Two Paradigms 14
1.1 Introduction 14
1.3.2 The interpretivist theoretical framework 23 1.3.3 The critical theoretical framework 24
1.4 The study design 25
1.5 Method of analysis 26 1.5.1 Trustworthiness 30 1.5.1.1 Credibility 31 1.5.1.2 Transferability 31 1.5.1.3 Dependability 32 1.5.1.4 Confirmability 33 1.6 Ethical Aspects 34 1.7 Conclusion 34
CHAPTER 2
2. Identity and Ideology (Part I): A Brief Contextual History of
Occupational Therapy in the Western World 36
2.1 Introduction 36
2.2 Therapeutic Occupation Prior to the Age of Enlightenment 39
2.3 Moral Treatment 42
2.3.1 The first steps to Moral Treatment: The Age of Reason 42 2.3.2 The high times of Moral Treatment 46 2.3.3 The decline of Moral Treatment: Moral Treatment making way for the
‘Science of Industrialisation’ 51
2.4 The Birth of Occupational Therapy: A Formative Period 55
2.4.1 1910s – World War I 59
3.1 1920s – The Beginning 64 3.2 1930s – A Female Profession Requiring Supervision 66 3.3 1940s – World War II: A Profession’s Growing Spurt 68 3.4 1950s – Founding an International Voice 69 3.5 1960s – Making a Paradigm Shift to a Reductionist Approach 71 3.6 1970s – OT Proving Itself Scientifically 74 3.7 1980s – A Profession Self-Reflecting 78
3.8 1990s – Comprehending Human Rights 81
3.9 Summary of Identified Ideologies in the History-Profile of OT 84 3.10 A Very Brief Account of the History of OT in South Africa 86
3.11 Conclusion 91
CHAPTER 4
4. Ideology and Occupational Therapy: a Systematic Perspective 92
4.1 Introduction 92
4.2 A Model for Ideology Critique 93
4.3 Occupational Therapy and the Ideological Environment 99 4.3.1 The realm of Discursive Domination 99
4.3.1.1 The ITM steering powers 100
4.3.1.2 The supporting ideals for the steering powers 106
4.3.1.3 Integrating discourses 108
4.3.1.4 Protective power 111
4.3.1.5 Pastoral havens 112
4.3.1.6 The spheres of the Discursive Realm 115
4.3.2 The realm of Social Domination 121
5. Occupational Therapy and Ideology: the Practical Issues 124
5.1 Introduction 124
5.2 Nature and Purpose of Chapter 5 127
5.3 Specific Ideology Concerns for (some) OT Practitioners 129
5.3.1 Clare – the Academic 129
5.3.2 Lerato – the Manager 135
5.3.3 Monica – the Medico-legal Expert 138 5.3.4 Jane – the Life-skills Specialist 141 5.4 Common Ideology Concerns for (some) OT Practitioners 146
5.4.1 Moral consciousness 146
5.4.2 The protective power of ‘Medicalism’ 151
5.4.3 Gender and Race/Culture 154
5.5 Conclusion 158
EPILOGUE
1. Concluding Remarks: Chapters 1-5 160
2. Possible Strategies for Treating the Ideology Infection of OT 166
APPENDIX A
170(Informed Consent) 171
APPENDIX B
173(Interview Transcriptions with Ideology Analysis) 174
LIST OF DIAGRAMS
Diagram I The Circular Relations between Critical Reflection,
Professional Craft Knowledge, Professional Epistemology
and Professional Identity 6
Diagram 1.1 A Model of Ideology Theory: Two Spheres of
Hypernormative Domination: ‘Discursive’ and ‘Social’ 28
Diagram 4.1 A Model of Ideology Theory 95
Diagram 4.2 Diagram of Discursive / Cultural Realm of Domination 100
Diagram 4.3 Diagram of Discursive / Cultural Realm of Domination:
Steering Powers and Supporting Ideals (Rationalisations) 106
Diagram 4.4 Diagram of Discursive/Cultural Realm of Domination: Steering
Powers, Supporting Ideals, Level of Protective Power 111
Diagram 4.5 Diagram of Discursive/Cultural Realm of Domination: Steering
Powers, Supporting Ideals, Level of Protective Power and
Level of Pastoral Havens 113
Diagram 4.6 Model of Ideology Theory: Spheres of Discursive Realm 115
Diagram 4.7 Model of Ideology Theory: Realm of Social Domination 121
LIST OF TABLES
Table 1.1 Types of Study 21
The only philosophy which can be responsibly practiced in the face of despair is the attempt to contemplate all things as they would present themselves from the standpoint of redemption. Knowledge
has no light but that shed on the world by redemption: all else is reconstruction, more technique. Perspectives must be fashioned that displace and estrange the world, reveal it to be with its rifts and crevices as indigent and distorted as it will appear one day in
the messianic light. To gain such perspectives without velleity or violence, entirely from felt contact with its objects – this alone is the task of thought. It is the simplest of all things, because the situation calls imperatively for such knowledge, indeed because consummate negativity, once squarely faced, delineates the mirror
image of its opposite. But it is also the utterly impossible thing, because it presupposes a standpoint removed, even though by a hair’s breadth, from the scope of existence, whereas we well know
that any possible knowledge must not only first be wrested from what is, if it shall hold good, but is also marked, for this very reason, by the same disproportion and indigence which it seeks to escape. The more passionately thought denies its conditionality for
the sake of the unconditional, the more unconsciously, and so calamitously, it is delivered up to the world. Even its own impossibility it must at last comprehend for the sake of the possible. But beside the demand thus placed on thought, the question of reality or unreality of redemption itself hardly matters.
ACKNOWLEDGEMENTS
I wish to express my deepest gratitude and appreciation toward the following individuals/institutions:
My supervisor, Prof. Johann Visagie (Department of Philosophy, UFS) for his enduring guidance, support and commitment to this project and ultimately for masterfully schooling me in what it means to be a teacher.
My co-supervisor, Mrs. Rita van Heerden (Department of Occupational Therapy, UFS) for her input and consistent encouragement from the commencement of this project in 2002.
All family (including my sisters Eloïse and Lorette), friends and colleagues for their continuous support.
All members of the Philosophy Department (UFS), including Joey, Martin and Matau for their assistance and encouragement in this study. Mr. Nico Benson on behalf of the Strategic Fund, UFS for the monetary
aid that contributed in realising this project.
Mr. Cloete Greeff (UFS), for his generosity in patience and technical assistance in the re-construction of the diagrams depicted in this study. Mrs. Carol Keep for the professional and timely proof-reading and
editing of the study.
All of the participants for their time and partaking in this project.
My parents, Len Rauch and Miems Rauch who selflessly afforded me the luxury of tertiary education after school.
JC van der Merwe, my husband and true companion for his invaluable, unrelenting and self-sacrificing support and contributions throughout this project that in the end also allowed for its completion.
My son, Heyter who invariably leaves me in awe when I witness the meaning of creativity…
Preface
Occupational Therapy is the art and science of the use of daily activities in order to treat or prevent sickness and thus learning necessary skills, or to compensate for the loss thereof, as required for successful personal independence, work, play and recreation (Information brochure, School for Allied Health Professions, UFS, 2003).
A very competent and experienced practitioner in occupational therapy asked me recently what made me choose to go into the field of occupational therapy. While it is certainly an important but difficult decision to make at the age of 18, I recall that I knew I wanted to go into the ‘helping business’. While studying to be a medical practitioner seemed the obvious and most prestigious choice, it was too expensive. (I will return to the aspect of prestige during the course of my theoretical analysis). Subsequently, psychology seemed to be the next best option. Nevertheless, in my mind’s eye, it appeared that I would have difficulty sitting passively, ‘only listening to people’s problems’. Thus, I heard from one of my classmates that her sister was studying occupational therapy. Until now, I cannot remember how she defined it, but I do remember her ‘definition’ included working with sick/ill people and being creative in the process.
In this description, I encountered a crucial concept that would crop up many times in the following study: that of creativity. Thus, I embarked on the journey of occupational therapy. I studied for four years and was taught that occupational therapy ‘equals activity’. I learned that each patient is assessed in terms of his/her five basic abilities (performance components): sensory, motor, cognitive, affective and conative. When these components are affected by disease or dysfunction, they may - when appropriate - be ‘remediated’. These basic abilities enable a person to engage in ‘activity performance’ or performance areas e.g. personal care, interpersonal relationships, life-skills,
work, play and recreational activities. When adversely affected, these abilities may be ‘rehabilitated’. I learned that our task is to strive to help our patients to become independent, have balanced occupations and as therapists, always to bring in activity as treatment.
I graduated and then worked at a private facility for people with alcohol and drug dependency problems, for a few months. The high standard of my undergraduate education and training enabled me to leave South Africa for some years to work abroad. There I became aware that the boundaries between occupational and physical therapy were a transverse division between the top and bottom half of the human body. OTs treated upper extremities and PTs the lower extremities. Overseas, I learned that unit targets had to be reached, careful documentation had to be completed every day, justifying exactly (read ‘quantifying’) how progress was made in strengthening the upper extremities (by means of the amount and frequency of resistance that the patient could manage with ‘Thera-band’ or weights). I gratefully learned how to use other physical agents such as ultra-sound, paraffin baths and so on and enjoyed the clear-cut boundaries, as well as knowing exactly what was expected.
Returning to South Africa, I realised just how much the international working experience had benefited me and I was appointed at an international company in the sector of ‘Disability Management’. It was my task to review all medical records of a client and based on those, (and often including an occupational therapy report from a private OT practitioner), conclude whether a person qualified as medically unfit to continue with his/her ‘own or any other occupation’. In my infrequent personal encounters with the often anxious client who was being assessed, and in accord with the practice protocol of the company, I usually explained that the occupational therapy evaluation is the last step before a final decision is made. Furthermore, I tried to clarify whether such an occupational therapy assessment mainly entailed an evaluation that gave the assessor a picture of how the person functioned in his/her everyday life.
Here I became aware of a sense of uneasiness after having to deal with clients who were able to qualify relatively easily for vocational disability, and, subsequently receiving 75% of their salary. However, they would be re-evaluated again after a period of two years; this time, with different criteria that stipulated an ‘ability to work in any other occupation‘. Thus, I witnessed many cases of individuals who were allowed to stop working by the system; being removed by this system from an open labour market for two years, then were expected to return to the same open labour market with little control over their responsibility for facilitating and maintaining their rehabilitation.
After having relocated, I started a private practice in the psychiatric field of occupational therapy, being privileged to work as part of a multi-disciplinary team, which included psychologists and a psychiatrist. I soon became aware again of the professional hierarchy in such multi-disciplinary teams and also of the fact that occupational therapy, although being valued, continues to be viewed as an accessory and not of cardinal importance to the treatment of a patient. Within the facility where I worked, it was occupational therapy’s responsibility to orientate each group of patients to the multi-disciplinary standard programme that was followed. We would explain to the patients that there were different role players in the multi-disciplinary health team. We would usually explain that the psychiatrist is the primary therapist or ‘gate-keeper’, who ensures that they receive the correct medication for specific diagnoses. The psychologist would speak to them about their inner worlds and the inner dynamics that had contributed to their current states, while the occupational therapist would teach them skills that would empower them for the future, such as self assertiveness, for example.
At the present time, I am privileged to have taught occupational therapy for a few years at a university (UFS). However, after all the learning processes and experiences that I have recounted above, the following burning question is for me, more prevalent than ever: “Why does occupational therapy continue to have identity problems?”
When informally discussing these questions with a colleague, it was remarked: “But are you not outside the boundaries of occupational therapy already, when asking such a question?” Upon reflection, it seems that the latter remark is both right and wrong; right, because the themes referred to above are indeed not part of ‘ordinary, everyday’ occupational therapy, but wrong, because they are an inherent part of the underlying philosophy of occupational therapy. It is with a view to the partial and tentative exploration of these central and indeed foundational issues, that the following study was undertaken.
SYNOPSIS
Occupational Therapy’s (henceforth referred to as OT) self-concept apparently remains, for all practical purposes, not well defined. While the complexity of the OT profession’s definition and their subsequent difficulty of articulating this might point to the very unique character of the OT profession, it does not follow from this that its future relevancy is therefore ensured. It is furthermore contended that due to the ongoing self-definition of the profession, there is a globally increased focus on occupational therapy’s values and philosophy about our relationships with not only those to whom we render a service, but also the environmental realities we form part of.
An inevitable link is indicated between critical reflection in OT practice, and the profession’s identity. While research on reflexive practice may be associated with the critical theoretical framework or critical social theory, this type of research in OT appears to be relatively scarce, and is mostly associated with research topics pertaining to clinical reasoning.
In order to explore one possible path through these complex problems, this study turns to the core field of philosophy, which is that discipline that studies essentially the foundations of disciplines (among other things). The present study will avail itself of a specific philosophical and sociological tool namely ideology theory. Currently, little or nothing is known about the presence of specific ideologies in the field of OT. Ideology theory is closely related to critique and self-reflection.
The main aim of this study is to perform a critical analysis of the presence of ideology in the profession of OT, by applying a three-dimensional ideology analysis. In order to meet this aim, an innovative approach had to be followed during which a unique methodology is argued. This study is subsequently typified as a (so-called) non-empirical type of research, based on a critical theoretical framework, using philosophical analysis as a study design, specifically applying ideology critique as a method of analysis.
In accordance with existing approaches in ideology theory, this study focuses on three levels of analysis in its own model of ideology critique: the socio-historical analysis of concrete contexts of domination (Chapters 2 & 3 and 5) the formal-structural analysis of the theory (model) of ideology critique that is used (Chapter 4), and finally, a creative end-interpretation of these analyses (Epilogue) with suggested perspectives for the ‘de-idolized’ future of OT.
The ideology critique model (Ideology Typography of Modernity or ITM) applied in this study revealed a systematic identification of ideologies that are present in the OT profession. These analyses show that ideology critique may serve as a methodical tool for critical self-reflection, offering a limited but penetrating perspective on the ‘deep structure’ of OT discourse.
SINOPSIS
Die self-konsep van Arbeidsterapie (voortaan AT) bly klaarblyklik vir alle praktiese doeleindes nie goed gedefinieerd nie. Terwyl die kompleksiteit van die AT professie se definisie en die feit dat hul dit moeilik vind om dit te artikuleer dalk juis mag dui op die unieke karakter van die AT professie, kan dit nie afgelei word dat die beroep noodwendig relevant sal bly in die toekoms nie. Weens die beroep se voortgaande self-definisie word daar verder aangevoer dat globaal meer gefokus word of AT se waardes en filosofie oor hul verhoudings met die mense aan wie hul ‘n diens lewer sowel as die omgewingsrealiteite waarvan hul ook deel vorm.
‘n Onvermydelike aansluiting word aangedui tussen kritiese refleksie in AT praktyk en die beroep se identiteit. Terwyl reflektiewe praktyk geassosieerd mag wees met die kritiese teoretiese verwysingsraamwerk of kritiese sosiale teorie, blyk hierdie tipe navorsing in AT taamlik skaars te wees en word meestal met navorsingstemas oor kliniese beredenering verbind.
Ten einde om een moontlike weg deur hierdie komplekse probleme te verken, draai hierdie studie na die kernveld van filosofie – die dissipline wat essensieel die grondslag van alle dissiplines bestudeer (onder andere). Die huidige studie gaan die geleentheid te baat neem om ‘n spesifieke filosofiese en sosiologiese hulpmiddel naamlik ideologieteorie te gebruik. Tans is daar min of niks te wete oor die teenwoordigheid van spesifieke ideologieë in die veld van Arbeidsterapie nie. Ideologie teorie hou strykelings verband met kritiek en self-refleksie.
Die hoofdoelwit van hierdie studie is om ‘n kritiese analise van die teenwoordigheid van ideologieë in die AT beroep uit te voer, deur ‘n drie-dimensionele ideologie analise toe te pas. Ten einde hierdie doelwit te bereik, moes ‘n innoverende benadering gevolg word waartydens ‘n unieke metodologie beredeneer is. Hierdie studie word dus getipeer as (sogenaamde) non-empiriese tipe navorsing, gegrond op ‘n kritiese teoretiese
verwysingsraamwerk, met die gebruik van filosofiese analise as ‘n studie ontwerp, en waartydens spesifiek ideologiekritiek as metode van analise toegepas word.
In ooreenstemming met bestaande benaderings in ideologiekritiek, fokus die huidige studie op drie vlakke van analise binne die studie se eie model van ideologiekritiek: die sosio-historiese analise binne die konkrete kontekste van dominasie (Hoofstukke 2 & 3 en 5), die formeel-strukturele analise van die teorie (model) van ideologiekritiek wat gebruik word (Hoofstuk 4) en eindelik, ‘n kreatiewe eindinterpretaise van hierdie analises (Epiloog) met voorgestelde perspektiewe vir die ‘gedeïdeologiseerde’ toekoms van AT.
Die model vir ideologiekritiek (“Ideology Typography of Modernity”, of ITM) wat in hierdie studie toegepas word, onthul ‘n sistematiese identifisering van ideologieë wat teenwoordig mag wees in die AT professie. Die analises dui daarop aan dat ideologiekritiek mag dien as ‘n metodiese hulpmiddel vir kritiese self-refleksie, wat ‘n beperkte maar deurdringende perspektief bied van die ‘diep struktuur’ van AT diskoers.
INTRODUCTION AND OVERVIEW
Citizens who cultivate their humanity need, further, an ability to see themselves not simply as citizens of some local region or group but also, and above all, as human beings bound to all other human beings by ties of recognition and concern. The world around us is inescapably international (Nussbaum 1997:10).
1.
A Question of Being Relevant: The Occupational Therapy
Identity
Imagine if we lived in a reality where occupational therapy (henceforth OT) is not only a concept that everyone knows and thinks of as synonymous with the human rights of health and well-being, but where it is also regarded globally as essential in realising these rights (OHCHR 1996: 4). This would be a world where OT is seen as fundamental to global humanitarian relief programmes, and where the true potential of this profession may be appreciated by every human being. This would be a reality where OT practitioners fully recognise the complexity of the twin themes of meaningful occupation and health (Wilcock 2000:81) and where occupational therapists (henceforth referred to as OTs) fully understand the relations between the philosophical base of the profession and its theory and practice (Ikuigu & Rosso 2003). A reality where OT is in a position to contribute to political and administrative decision-making to ensure occupational justice for all humans (WFOT 2006; Wilcock 2001:5).
Given that the OT profession is less than one-hundred years old, it is not surprising that this profession continues to make significant advances in theory
and practice; a fact that some take as a confirmation of the remarkable and innate characteristic of the profession’s adaptability. On the other hand, other matters that also have become part of the profession’s ‘character’ are more problematic. These issues have not dissipated since the founding of the profession, or at least it seems that not enough has been said or done for generally accepted resolutions to be achieved. One such concern is the identity problems of OT (Blair & Robinson 2005; Creek, Ilott, Cook & Munday 2005; Fisher 2003; Ikuigu & Rosso 2003; Ikuigu & Schultz 2006; Hooper & Wood 2002; Watson 2006).
Chevalier (1997:540) states that after scrutinising many issues in relevant OT journals, his long-standing impression is confirmed that OT as a profession is still in the process of defining itself and still in search of its own, ultimate meaning. This resonates with De Witt’s (2002:2-3) presentation on the theme of “Pathways” during the 19th Vona du Toit Memorial Lecture, in which she also
discusses, for example, the many ambiguous views and definitions of the concept of ‘occupation’. She further states:
Consensus around key terms is important for dialogue with-in and outside the profession and for the development of coherent models and tools for practice...there is an urgent need for the profession to address and get consensus on its professional language.
OT’s self-concept apparently remains, for all practical purposes, not well defined. While the complexity of the OT profession’s definition and our subsequent difficulty of articulating this (De Witt 2002:3) might point to the very unique character of OT (Creek 1994:23), it does not follow from this that our future relevancy is therefore ensured (Joubert 2003:3; De Witt 2002:6). It is also contended that due to the ongoing self-definition of the profession, there is an increased focus on OT’s values worldwide and its relationships with not only those to whom they render a service, but also the environmental realities that
they form part of (Kronenberg & Pollard 2005:1). It is further argued that because of the very growth of the OT profession, it is increasingly challenged to shift the now less adequate boundaries and definitions of what has previously been viewed as ‘holistic’ (Kronenberg, Simó Algado & Pollard (eds.) 2005:56).
Many explanations may be proposed for the profession’s identity problems. One line of reasoning is that of the tensions within the theoretical paradigm of the profession, as well as the conflict between OT philosophy and practice. Incongruent philosophical paradigms such as pragmatism and structuralism are recognised as having had significant influences on the professional stance of OT (Hooper and Wood 2002; Ikiugu & Schultz 2006; Wilcock 1998:178-179; Wilcock 2002:41-44). It is therefore apparent that a continuous dialectic exists between the OT profession’s philosophy of health associated with the medical model and its deep and central allegiance to occupation (Wilcock 2000). This dialectic appears to inform the profession’s search for a balance between concepts, such as ‘art’ and ‘science’, ‘holistic’ and ‘functional’ and ‘body’ and ‘mind’ (Mattingly & Flemming 1994:302; Peloquin 2005). Moreover, similar discrepancies are echoed in discussions of the field of research in the OT profession:
A consequent dissonance is evident between ontological assumptions, ways of generating knowledge and practice within occupational therapy (Blair and Robinson 2005:269).
In the same vein, Hagedorn (1992:3-4) points to two main and “incompatible” views in the philosophy of the OT profession: that of the reductionist and the holistic perspectives.
Wilcock (2000:1) proposes that one of the ways of consolidating such tensions and developing a uniform OT identity, is to build “a personal, professional, and educational philosophy grounded in the association between occupation and health”. Some argue for pragmatism as such a philosophy, since this is supposed
to be the closest to the ontological assumptions of the OT profession (Breines 1986; Hooper and Wood 2002; Ikiugu 2004; Ikiugu & Schultz 2006;). Conversely, Blair & Robertson (2005:275) conclude that “[o]ccupational therapy lies on a medical/social fault line and, as such, is theoretically eclectic and epistemologically pluralistic”.
Another line of argumentation that offers an explanation for the identity problems of the OT profession is the one about the very complexity of OT as such. This notion acknowledges that the OT process per se is individualised and unique to every client. The process is described as being complex and contingent as it is shaped by many ‘variables’, such as the therapist and the client within his/her own environment, context, worldview and experience history, and what individuals perceive as ‘meaningful occupation’ (Creek, Illot, Cook & Munday 2005:281-284; Whiteford, Klomp & Wright-St Clair 2005: 3-15).
Ruth Watson (2006) corroborates this line of reasoning by arguing that it is important to appreciate the cultural identity (“essence”) of the OT profession. She points to the fact that while the OT profession might share a global philosophical/theoretical basis, OT practice as such, cannot be uniform. The reason for this is that the occupations, which are the vehicles for therapeutic means, are indeed very culturally-specific and should be, if occupation is to impact on people’s lives for health and well-being purposes (Watson 2006; WFOT 1999:6).
The above rough sketch of the ‘state of the art’ in OT is meant to provide an initial image of the issues that motivated me to undertake this study. I wanted to bring some perspective to the above-mentioned problems that plague the profession. I also realised that one could not address these issues haphazardly, reflecting on them one by one, and by trusting one’s own ‘gut-feelings’.
Therefore, I chose to turn to a philosophical/sociological theory that I had become acquainted with; a certain model of ideology theory called the Ideological Typography of Modernity (ITM). I wanted to see how OT would come out from a ‘confrontation’ with this theory, which deals in a very specific way with value, power and domination. This confrontation (of diagnostic analysis) would be between the model of ideology (ITM) and OT discourse, to probe the possible ideology content of this discourse and practice, as well as between this model and the culture and society in which OT finds itself. With reference to the latter and for the purposes of this study, I shall take this culture to be that of modernity in its broadest sense - defining ‘modernity’ as Western culture since approximately the 17th/18th century. However, this model does not hold that
development and progress have to be Western to count as such – that would be regarded as Eurocentric. Even in developing countries such as South Africa, other cultural contexts are very much interwoven with the culture of modernity. All of this is closely related to critique and self-reflection.
2.
The OT Identity and Critical Self-Reflection: Choosing and
Articulating a Suitable Epistemology
Much is being said nowadays about reflective and reflexive practice in OT. While these two terms are often used as synonyms, some authors however, make a distinction. Finlay (2002:532-533) differentiates between these terms in the sense of referring to reflective practice as a concept that entails the contemplation about something external from the practitioner that occurred in the past. Additionally, she describes reflexive practice as a continuous process that occurs more internally and entails a “subjective self-awareness”. Blair and Robinson’s (2005:270) analysis of these terms are similar and add that reflexive practice is “about subjecting your own knowledge claims to critical scrutiny”. Whether one chooses to perceive these terms as being synonymous or not in day-to-day practice, critical reflection has become a crucial principle in health
care practice (Gamble, Chan & Davey 2001; Whiteford 2005:45) and is stated by WFOT (World Federation for Occupational Therapists) as one of the skills required by an OT for competent practice (WFOT 1999:8).
Whiteford (2005:44-46) also indicates an inevitable link between critical reflection in OT practice and the profession’s identity. Critical reflection is regarded as the basis of the “craft knowledge” of a profession, and it appears that this skill (critical reflection) indeed resonates with the ‘artistry’ feature of the definition of OT. However, for a profession to remain relevant in an “era of accountability”, it needs to be able to clearly articulate its epistemological (“how it comes to know” (Henning 2004:15)) foundations (Whiteford 2005:46). The latter is a point of contentiousness, as reflexive practice is generally associated with much subjectivity and lack of ‘evidence’ (Finlay 2002).
The following diagram may be argued as illustrating the above relations:
Diagram I. The Circular Relations between Critical Reflection, Professional Craft Knowledge, Professional Epistemology and Professional Identity.
Research on reflexive practice may be associated with the critical theoretical framework (Henning 2004:23) or critical social theory. (Detailed argumentation will be further outlined in Chapter 1.) This type of research in OT appears to be relatively scarce, and is mostly associated with research topics pertaining to clinical reasoning (Blair & Robinson 2005:274).
In one other study (using critical social theory), Mackey (2006) contends that a Foucaultian analysis of the oppressing powers of theoretical constructs and discourse in the OT profession, may assist the OT profession in creating a new, dynamic and authentic identity. Mackey (2006:5) points to Foucault’s argument for analysis entailing:
practice of the reflexive, ethical self [in which] mature judgement rests on the reflexive examination of contradictory possibilities and power relations within the professional discourses.
3.
The OT Profession Engaging in Systematic
Self-Clarification: Investigating Ideology Theory as a Means of
Critical Self-Reflection
In view of OT’s identity-dilemma and its links with reflexive practice, it may be said that contributions to define, clarify and argue the theoretical base of OT, are invaluable to the philosophical discourse of this profession. It is apparent from the OT literature that different and specific angles have been used to serve as means of such self-reflection. Compare frameworks such as those of structuralism, pragmatism, complexity theory etc. As mentioned above, my own contribution to this debate is to explore one encompassing sociological and philosophical tool for the purpose of professional critical self-reflection: that of ideology critique.
The ideology tool (as outlined in detail in Chapter 4) that this study will implement, seeks to analyse both conceptual distortions (relations of conceptual domination) and social relations of domination. An example of the former is the technocratic management of illness, where technological considerations may come to distort or dominate ethical norms, authentic communication, principles of patient care, and so on. An example of social ideology may be found in relations of domination that may function within institutions such as universities or hospitals or the families from which patients come. Such relations may be centred on various indicators such as class, gender, race, age, etc. Ideology analysis also aims at analysing possible links between conceptual distortions and relations of domination.
In this introductory context, I wish to point to two main characteristics of ideology:
It has an aura of exclusiveness where the nature of certain ideas, judgements and perceptions are viewed as non-negotiable.
When criticised, ideology cultivates the fabrication of enemy-images, serving as a shield for the self-appointed privilege to deflect criticism at its own convenience (Schoeman 2000:14-15).
As for the pervasiveness of ideology, I can only refer to Schoeman’s remark: “it adversely affects every mode of human existence, every aspect of human culture, and every structure in society” (Schoeman 2000:12).
However, little or nothing is known about the presence of specific ideologies on the development of occupational therapy as a profession. This could be one of the reasons why this profession, along with other professions such as nursing, is viewed as secondary and restricted to the realm of medical science and is therefore, mainly the business of treating illness. In exploring the global history of
the medical and related professions, it becomes clear that one form of ideology, namely patriarchy (the domination of ‘male-ness’), has shaped their development, which in turn, explains why occupational therapists (for example), which is a female dominated profession, are considered as merely assistants of doctors (Capra 1983:121-122).
Consequently, the premise of this study is that ideology has had and still has an influence on the professional standing of occupational therapy, and might therefore, to some degree, account for the identity problems of this profession.
The main aim of this study is to perform a critical analysis of the presence of ideology on the profession of occupational therapy by applying a three-dimensional ideology analysis (Thompson 1990:307-313), as discussed in detail in the following chapters. A secondary purpose is to establish and outline an appropriate research methodology (Chapter 1) that can accommodate the stated aim. This calls for an innovative approach that, to my knowledge, has not been attempted previously in the OT profession.
The value and significance of this study lies in demonstrating the importance of ideology critique as a tool for critical self-reflection in OT’s quest for creating a clear and sustainable professional identity. There is a vital link between OT’s critical self-reflection and ideology critique: that is the search for ‘truth’; the truth, or authenticity of OT as a profession. However, having said this, it has to be recognised that pure and complete truth in this regard is hardly attainable in the human life-world. The reason for this is that human access to unadulterated reality is always limited and distorted.
It is limited because human beings are just that: human, and therefore structurally shaped by our evolutionary history to have only a very specific kind of access to all of reality that is ‘out there’. It is distorted, because all individuals (including the researcher), are subjected to their unique worldviews, histories and
perceptions. These are always tainted by false impressions, even though we are unaware of them. It is important to note though, that these very considerations that caution us to be realistic in our attempts to root out the ideologies in our world and in our profession, are part of ideology critique itself.
Hopefully this study will also illustrate the importance of owning basic knowledge about ideology critique, thus empowering members of the health profession to gain an accountable and insightful sensitivity toward cultural differences, as well as truly comprehending their own worldview and subconscious frame of reference when dealing with members from other cultures, which is so relevant and necessary in Africa.
4.
Clarification of Terminology Often Used
Since this study is a focused ideology critique of the OT profession, the following concepts are contextually explained in detail in the following chapters. However, at this stage, a brief summary of certain technical terms might be useful:
Ideology: The negative phenomena of when a power (in a conceptual or
social form) is used for domination and which leads to distortion thereof e.g. techno-scientism, positivism, racism, elitism etc. For the purposes of this study it is understood not in the neutral sense of a ‘worldview’, but in the negative sense of distortion and domination, e.g. the idolisation of technology, or patriarchal domination.
Ideology theory: Refers to the model of ideology that will be used in this
study namely the Ideological Typography of Modernity (ITM - as outlined systematically in Chapter 4). ITM includes the two levels of domination, namely, conceptual/value/discourse domination (e.g. techno-scientism) and social domination (e.g. patriarchy or racism). The level of
conceptual/value/discourse domination progressively outlined in Chapter 4 from its macro to micro points, culminating in a depiction accordingly (Diagram 4.4, p. 111).
Ideology critique: The practical application of ideology theory, for
example (as in this study), to the profession of Occupational Therapy. Ideology critique may thus be defined as a critical awareness of when and how power is distorted.
ITM: “Ideological Typography of Modernity”. The specific model of
ideology theory that is utilised for the ideology critique of OT.
Hypernormalise: The absolutisation (idolisation) of one value above other
equally important values or aims, to the point that the former dominates the latter. Various ideologies are defined by various hypernormalisations – for example, in techno-scientism, we find a hypernormalised technology.
Hypernorm: While the verb for ideological dominations may be referred to
as ‘hypernormalise’, the noun for the same concept may be used as ‘hypernorm’. Synonymous to the latter is ‘hypervalue’. While I will refer to the act of ideological absolutisation as the hypernormalising of something, the resulting idolised form of that something will frequently be referred to as a hypernorm. For example, technology is obviously something that is necessary and useful, but in an ideological context it becomes a hypernorm.
5.
Overview of this Study
Chapter 1, The Nature of This Study: A Journey Between Two Paradigms.
This chapter entails a detailed explanation of, and argument for the type of research and methodology that has been employed in this study. A differentiation is made between empirical and non-empirical types of research and three different theoretical frameworks in research are explained. Based on the argumentation of the methodology, the researcher outlines the study design and method of analysis – the latter which includes criteria for trustworthiness. This chapter also includes the ethical aspects relevant to the type of study. Finally, there is some reflection on the importance of being critically aware of possible ideological distortions in research as such, strengthening the argumentation of the specific methodology in the present study.
Chapter 2, Identity and Ideology (Part I): A Brief Contextual History of Occupational Therapy in the Western World. This chapter involves a critical
ideology analysis of the historical profile of the OT profession. Since human occupation is the central part of the profession’s paradigm, the historical context of occupation going back to ancient and classical times, is taken into consideration. The time line is continued up to the Age of Enlightenment and further to include Moral Treatment - a significant period for the profession. The ideology analysis continues to the birth of the profession in the early 20th century,
and its formative period up to the end of World War I, which indirectly led to the commencement of OT as a profession.
Chapter 3, Identity and Ideology (Part II): A Brief Contextual History of Occupational Therapy in the Western World. In this chapter the
socio-historical ideology analysis of the OT profession continues from the 1920s up to the end of the 20th century. The ideologies that have been identified through the
South African, a very brief account (due to the lack of suitable documentation) of the history of the OT profession in this country is included.
Chapter 4, Ideology and Occupational Therapy: A Systematic Perspective.
Here the researcher presents a systematic analysis of the tool (ITM model) that is used for ideology critique in the present study. The analysis first explores the different levels and spheres of the discursive realm, relating each of these levels of ideology domination to the discipline of OT in general. It then moves to the social realm of ITM, using the same method of analysis.
Chapter 5, Occupational Therapy and Ideology Theory: The Practical
Issues. This chapter demonstrates how the ideological ‘landscape’ concretely
affects the lives of practising OTs. This is done by interviewing four experts in the profession, representative of four different fields in OT. This chapter aims to illustrate the premise of the study: the presence and influence of ideology in the lives of OT practitioners, as well as in the identity perception of the profession.
An Epilogue, concludes the study. This entails a final, creative interpretation of all the forgoing systematic and socio-cultural analyses, and also suggests some perspectives for the ‘de-ideolised’ future of OT.
CHAPTER 1
The Nature of This Study: A Journey Between Two
Paradigms
1.1 Introduction
The idea for this study originated between two partners, one being an occupational therapist (the researcher), and the other a philosopher (my husband), at a national occupational therapy conference in South Africa when we presented a paper entitled "What is in a name? Defining Occupational Therapy".1
The title obviously sounded rather presumptuous, but was chosen deliberately in an attempt to re-open the debate about some existential-problematic issues in the OT profession.
Over the following few years the idea evolved into a topic for research.2 The
project came to be seen as an investigation of the ‘ideological profile’ of OT. A research proposal had to be constructed for the purpose of obtaining the Faculty of Health Sciences’ approval in order to register the title. The proposal was submitted to a thorough process of clarification in accord with good academic and ethical practice. However, it was clear from the beginning that this attempt did not conform to the traditional structure of studies usually conducted within the faculty. One of the reasons for this was that the present study’s main aim was not to gather ‘data’ in the traditional sense where the involvement of ‘research participants’ in one way or another is automatically viewed as part of the research process.
1 Occupational Therapy Association of South Africa national conference at the University of the Free State
(UFS), in Bloemfontein, South Africa, 23-25 September 2002.
2 There have always been attempts to ‘define’ concepts like ‘research’ in and of themselves, quite apart
from actual research programmes in which they are functioning. For example, while research is defined as “to know”, epistemology as the “philosophy of how we come to know”, methodology is defined as the “practice of epistemology” (Henning 2004:15).
Moreover, in spite of rigorous explanations about the nature of ideology critique, substantiated by reputable social and philosophical resources, much collective confusion about the type of research continued to exist within the sub-structures of the faculty. Even at the point of being approved and ‘recognised’ (on the level of the School of Allied Health Professions of the UFS) as a non-empirical type of basic research in the shared disciplines of occupational therapy and philosophy, the proposal was still submitted to the Ethical Committee of the faculty, which in turn required as a prerequisite, a letter of endorsement from the Biostatistics Department before the protocol could be submitted for approval on a faculty level.3 Interestingly, the input of Biostatistics was also required at the
presentation of the proposal, this notwithstanding the fact that no statistical data would be involved in the study. ‘Ethical’ considerations which are usually accepted as standard practice (in contrast to, for example, requirements in the Faculty of Humanities) had to be adapted in an attempt to conform to the prescribed structure of a protocol.
The problem behind getting the proposal for this study approved, probably did not lie in an ineffective process, or in wilful misunderstandings or in agendas that might have been malevolent – my experience was actually to the contrary. The dilemma here appeared to be an “unbridgeable chasm” (Usher 1997:5) between two paradigms in research – the so-called empirical and the non-empirical paradigms.
As a faculty member in OT with interests in Philosophy, I was asking: How is it possible that in the same University within the ‘universitas’ (unity) of learning, such a chasm of incomprehension between two mountains of epistemology can
3 Actually, the above use of the term ‘empirical’ often reflects the kind of ideological influence that is the
object of this study. At issue here is a positivist worldview (I will return to this theme in later contexts) that links ‘the empirical’ to criteria such as case studies, interviews, numbers, graphs, etc. But the ‘reality’ to which ‘empirical’ refers, is after all, much wider than these extremely (empiricistically) narrowed-down aspects of reality. It could be argued that all disciplines and their theories are ‘empirical’ in nature – also ideology theory (and its perspectives in OT). There are many aspects to empirical reality. However, for present purposes, I will make (some) use of the term ‘empirical’ in its more traditional sense.
exist?4 On the other hand, I am sure that my experience is not that rare. The
basic problem here is the “incommensurability” (Kuhn 1970:150) of paradigms.
Of course, in this situation I was confronted by the valid question as to why this study should qualify for formal registration within the discipline of Occupational Therapy, considering that the ‘methodology’ (I was going to use ideology theory) is situated within the disciplines of sociology and philosophy.5 A few arguments
may be presented here.
Firstly, while OT is regarded as an applied science, does this imply that one may not ask research questions other than those that will provide ‘yes’ or ‘no’ answers? And if this were to be the case, how have the theoretical foundations of the discipline (or any discipline for that matter) then been established? May we not rather say that all academic disciplines are born out of ‘non-empirical research’; that is, questions and perspectives preceding data gathering? In this sense, ‘theory’ actually precedes observation (Popper 1965; Popper 1972: 81, 258).
Secondly, when asking the really deep and therefore philosophical ‘why’ questions in any discipline, it does not automatically render the research as being in the discipline of philosophy. The purpose of this study is to explore some of the identity problems of occupational therapy with the hypothesis that ideological theory might shed some light on them. But similar questions may be asked in any discipline without the raising or the answering of the questions taking leave of the discipline in which they are asked.
4 Epistemology deriving from the Greek word episteme, directly translated as “knowledge” and in its
applied sense means “how we come to know” (Henning 2004:15) or “authentic / truthful knowledge” (Mouton 2001:138).
5 For some, methodology is defined by the theory of knowledge while research methods are the ‘techniques
The third and main argument however, is that the object (purpose) of any field of research question indicates the methodology.6 In other words, methodology is
subordinated to the subject/object of research and not the other way around. The object of research should indeed determine the methodology. Methodology is not a primary concept but a secondary one; there is not a ‘discipline’ of methodology as compared to epistemic disciplines such as history, linguistics, economics or even OT.7 Nor should methodology be defining of OT. One of the five principles
that are said to constitute the ethos of OT is that OT is as much a science as it is an art and that being prescriptive about certain types of research, especially the positivistic kind, may be damaging to health professions such as OT (Peloquin 2005:613-619). Rather, the latter concerns itself with the human being in multiple contexts and who, in recent times, only started clarifying “its own unique epistemological foundation of occupation” (Whiteford 2005:41).
Being in awe of a ‘methodology’ separated from the actual goal of a research programme, may be compared to producing and sharpening a knife endlessly without starting from a clear idea of what particular use to which the knife is suited.
The present chapter will therefore focus on the “argument of methodology” or “methodological reasoning” as it is referred to by Henning (2004: ix).
In many ways, the methodology of the present study is an attempt to remain true to the ‘artistic’ part of OT's definition, while acknowledging the ‘scientific’ aspect of it (Peloquin 2005: 613, 616-619). This is especially so if the ‘scientific’ aspect is equated with the way things are done in the natural sciences.
6Harvey (1990:1) attempts to define methodology as "the point at which method, theory and epistemology coalesce.”
7 ‘Epistemic’ is defined by some as “the scientific study of knowledge, as opposed to the philosophical
It should be noted that some of the subtitles of this chapter will be familiar and in accordance with the generic structure of a traditional chapter on methodology with respect to applied research in OT. Other traditional subtitles will be omitted because of their irrelevance/inappropriateness to this type of research, though the issue itself will receive attention throughout.8
In terms of one possible methodological approach, the present study will qualify as a (so-called) non-empirical type of research, based on a critical theoretical framework, using philosophical analysis as a study design, specifically applying ideology critique as a method of analysis (Henning 2004:23; Mouton 2001:178). Given that this description of research might appear unfamiliar and indeed quite ‘untraditional’ within the positivist epistemological framework, which is regarded as traditional within the Health Sciences, I will now attempt to explicate these concepts in a logical and orderly way.
I shall start with defining the type of research engaged in, illustrating why and how it differs from a traditional empirical study that requires positivist parameters. Following this, a distinction will be made between the three epistemological frameworks, once again exemplifying how the epistemological framework of this study differs from a positivist or an interpretive framework, which usually makes use of quantitative and qualitative study designs, respectively. Finally, I will return to the subtitles ‘study design’ and ‘method of analysis’, in describing these concepts according to the nature and type of this study.
8 It needs to be mentioned that the rationale, as well as the aim, and value and significance of the study have been fully covered in the Introduction and Overview.
1.2 Type of Research
The term ‘research’ is derived from the Latin word, which means 'to know'. Although many textbook ‘Introductions’ make much of the etymological origin of terms, such definitions per se, do not provide satisfactory explanations. It is important to remember that linguistically, contemporary contexts determine the meaning and use of words. The interpretation of the word ‘research’ also varies from different perspectives and even from different frameworks of knowledge. For example, empirical research is, in general, defined by the systematic or logical investigation of, or inquisition for, knowledge (Katzenellenbogen, Joubert & Abdool Karim 1997:3; Huysamen 1993:35-36).9 A more specific definition for
research, from an empirical framework for example, would be: “a systematic process of gathering and synthesising empirical data so as to generate knowledge about a given population for a selected topic” (Bailey 1997:1). At least in this description, the terms “data” and “population” seem to point to the characteristic attitude of the researcher.
Another approach is that in its broadest sense, research may be defined as a way in which to find an answer to a problem; a way to seek the best answer by obtaining the best possible solution (Hammersley 1995:102; McKenzie 1997:8). In order to provide the most appropriate solution to a certain question, the process of finding such an answer should be pursued by the methodology as already discussed.
Research is further divided into two main streams: basic or fundamental research, and applied research. While applied research uses already existing knowledge in order to expose general laws of connection and/or causal factors that apply to a certain group at a certain time, basic research concerns itself with
9Again, this definition of research is not wholly satisfactory from an ideology-critical point of view.
Obviously, ‘system’ and ‘logic’ are not defining for scientific research only. They also occur in everyday life, when someone goes about some or other task logically and systematically.
generating fundamentally new knowledge (Katzenellenbogen et. al. 1997:3; Huysamen 1993:35-36).
In terms of the basic or applied type of research, the present study would clearly belong to the former type, but this is as far as OT is concerned. As far as the philosophical tool I am using is concerned, my investigation would count as the application of a given theory.
Once again, I have to emphasise that the importance of the purpose of the research, as well as the nature of the research question, determines the appropriate methodology. Finlay (2006:325) states in this regard: “If a piece of research is to be evaluated, it needs to be evaluated on its own terms”. In accordance with the design of this study, which is a philosophical analysis, the study seeks not to find ‘empirical’ answers, but rather answers about the meaning of the role of ideology in OT.10 My own view, derived from philosophical
discussions, is that research is geared toward aspects and from their coherence with other aspects of reality, which is abstracted from everyday contexts.11
To further elucidate, the ‘type of research’ question as it applies to the present study, I refer to Mouton (2001:57). He refines the differentiations of research by describing two main types of study, namely, empirical studies and non-empirical studies. Under the former reside traditional qualitative and quantitative studies. The latter is described as conceptual analysis, theory or model-studies, literature reviews and philosophical analysis. The following table provides a clear overview:
10 The study design will further be discussed under 1.4.
11 To illustrate the concept of looking at the realm of research through different spectacles, Dooyeweerd’s
analysis of the fifteen aspects of reality may be referred to. These aspects in order, are: number, space, kinematic, physical, biotic, psychic (psychological), logical, historical/formative, lingual, social, economic, aesthetic, juridical, ethical and belief/spiritual. Dooyeweerd’s aspect theory will receive further attention in Chapter 4 and in the epilogue. For further attention refer to L. Kalsbeek (1975).
TYPES OF STUDY
A. Empirical Studies
B. Non- Empirical
Studies
a) Using primary data
b) Analysing existing data
Examples of study designs include: Philosophical analysis, Conceptual analysis, Theory building, Literature reviews Examples of study designs include: Surveys, Case studies, Programme evaluation, Ethnographic studies
i) Textual data ii) Numeric
data Examples of study designs include: Discourse analysis, Textual criticism, Historical studies Examples of study designs include: Secondary data analysis, Statistical modelling
Table 1.1 Types of study (Mouton 2001:57).
It should be clear that the nature of this study entails a non-empirical type of research since it will not be making use of any ‘data’ (in a positivist sense), but will rather be generating some sort of new information by analysing what kind of ideologies have been and are influencing the stance of the OT profession.
1.3 Theoretical Frameworks
Most individuals in the Health Sciences will recognise that empirical studies are known to use either quantitative, qualitative or a combination of the two study designs. These study designs are usually classified as falling under the
“positivist” and/or “interpretive” frameworks. The study design of this particular study will be further explained as falling under the “critical theoretical framework”, although Henning (2004:23) does not acknowledge philosophical analysis as an example of this framework.
Henning (2004:15) states that the purpose of any study not only determines the chosen methodology of executing the study, but also needs to be grounded in an epistemological “home”, which she later refers to as a theoretical framework. Cognisance of the appropriate framework is of the utmost importance to avoid confusion when concerning oneself with research. Whether it is about deciding what the problem to be researched is, how to execute the research and - just as important - the reading of research, the end result is to deliver valid critique (even if it is within a tainted search for truth). Failing to know what the theoretical framework/context of the research is, may be compared to looking at the realm of research through a particular colour of spectacles and presuming that every researcher sees it in that particular way.
Henning (2004:17-27) distinguishes between three frameworks in “epistemology”, namely: positivist, interpretivist and the critical theoretical framework, respectively.12
1.3.1 The positivist theoretical framework
Typical examples of this type include survey studies, verification of hypotheses, measurement and scaling, statistical analysis and also in the post-positivistic paradigm, qualitative and quantitative
12 The critical examination of each of these theoretical frameworks in research is virtually a study on its
own and will not be explored in this chapter. The purpose of this chapter is to define and explain the methodology that has been chosen for the purposes of ideology critique and analyses in OT and its environment. Therefore, the ideological manifestations of theoretical paradigms in research will receive attention in ensuing chapters and within the context of the present study.
descriptive studies that usually capture meaning at the level of description only (Henning 2004:18).
The positivist framework, which I will later treat in a technical sense as an ideology, is intimately and explicitly related to ‘science' and empiricism of which the latter, in short, postulates that which is perceived through the physical senses of observation only, may be accepted to be true. Positivism in particular holds the philosophy that the only 'truth' is measurable (in so far as being observable, aside from logical and mathematical truths) and should be accurately described through data that are stripped from any ‘subjectivity’ (Popper 1972: 36n). Thus, the concept of verification is very important. Although some researchers within the positivist paradigm accept both quantitative and (most) qualitative data as ‘objective’, quantitative types of study generally remain higher on the hierarchy of repute and funding (Capra 1983; Finlay 2006:320; Gadamer 1996:2; Hammersley 1995:1; Usher 1997:1-7; Whiteford 2005:34-48;).
While the positivist type of study provides invaluable information especially for the Health Sciences and has increased the standard of health care practice (referring here to the Flexner Report in 1910 (HomeoWatch 2006; MedicineNet.com 2006)), the current day use of positivist research methods to me appears often to fall short of relevant, meaningful and substantial contributions to the theory (discourse) of OT. The use of the positivist framework will receive further critical attention in subsequent chapters.
1.3.2 The interpretivist theoretical framework
Whereas the positivist believes that the goal of science is to uncover the truth, the interpretivist believes the goal of science is to hold steadfastly to the goal of getting it right about reality or multiple realities even if we can never achieve that goal (Henning 2004:20).
